| Gaia: | We review the possibilities for and ethics of the use incentives and disincentives to increase
vaccination uptake. We argue that disincentives (or mandatory vaccination), such as fines,
restriction of movement or education and withholding of benefits can be justified depending on
four factors: the gravity of the public health emergency, the safety and effectiveness of vaccines,
the comparative expected utility of mandatory measures compared to other alternatives, and
the proportionality of costs imposed. We provide a decision algorithm for the ethical use of
incentives. Incentives face problems of undue inducement and exploitation. We propose a
novel Payment Model which would include economic costing of time, pain, risk of adverse
events, including death, and compensation. If education, encouragement and facilitation fail to
achieve herd immunity quickly enough, payment for vaccination maybe the fairest way to
facilitate uptake of vaccination.
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